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Chris Ham writing for The King’s Fund: NHS England’s belated decision to change the name of accountable care systems to integrated care systems has the virtue of describing more accurately the work being done in the 10 areas of England operating in this way. Despite this, there is understandable confusion in many quarters about NHS England’s plans, and uncertainty about what they mean for the NHS in the medium term.

Integrated care systems, as they were re-branded in updated planning guidance published recently by NHS England, bring together NHS commissioners, providers and local authorities to plan how to improve health and care for the populations they serve. For the organisations involved in these systems, lines of accountability remain unchanged. NHS organisations continue to look upwards to NHS England and NHS Improvement and local authorities look outwards to their communities. Many systems are also working to establish a form of mutual accountability in which the organisations involved hold each other to account for the delivery of their plans.

Mutual accountability hinges on the existence of a high degree of trust and respect between organisations and their leaders. It also requires the establishment of governance arrangements that support collaboration while respecting the statutory responsibilities of these organisations. Integrated care systems have no basis in law and they depend on the willingness of the organisations involved to think and act as part of a wider system even when it may not be in their interests to do so.

These systems also require NHS England and NHS Improvement to work together to oversee how areas working in this way are performing. This is beginning to happen in some areas through joint working by teams drawn from national bodies and the development of single regulatory oversight. NHS England’s expectation is that integrated care systems will become self-governing as they mature and that regulatory intervention will then be the exception rather than the rule, but this is some way off in most areas.

The updated planning guidance makes clear that integrated systems will become increasingly important in planning services and managing resources in future.

The updated planning guidance makes clear that integrated systems will become increasingly important in planning services and managing resources in future. The 10 areas already operating in this way will prepare a single system operating plan and take responsibility for a system control in 2018/19. The guidance also states that other systems will join the programme where they can demonstrate strong leadership, a track record of delivery, strong financial management, a coherent and defined population, and compelling plans to integrate care. The message could not be clearer: system working is here to stay.

Integrated care systems, like the sustainability and transformation partnerships from which they have evolved, are conscious workarounds which seek to make sense of the complex and fragmented organisational arrangements resulting from the Health and Social Care Act 2012. Changes to the law to regularise what is happening, included in the Conservative Party’s 2017 election manifesto, are off the agenda for the time being. This is because the government lacks a working majority and also because Brexit is dominating the parliamentary timetable.

The difficulty this creates is that workarounds are inherently unstable, even in the most favourable circumstances, and can only be sustained for so long. Informal mechanisms such as memoranda of understanding and partnership boards to underpin decisions about the use of NHS resources have a part to play but may break down when difficult decisions arise. There are worries too that decisions will be taken behind closed doors in forums that have no statutory basis and are not open to public scrutiny.

There are worries that decisions will be taken behind closed doors in forums that have no statutory basis and are not open to public scrutiny.

Changing the name of accountable care systems to integrated care systems will not distract attention from concerns by campaigners about a proposed national contract for accountable care organisations which they fear will result in ‘backdoor privatisation’. The contract is intended to be used by NHS commissioners who wish to undertake a competitive procurement process to integrate the delivery of care for their populations. NHS England has responded to the concerns raised by delaying the contract’s introduction and agreeing to consult on how it expects it to be used.

The puzzle is why the proposed contract is needed when many areas of England have already made moves to integrate care making use of existing legislative flexibilities. These areas are working with NHS providers to align hospital, community and mental health services, with GPs and adult social care services also involved in some places. They are doing so in a variety of ways, including through the use of alliance contracts and lead providers who subcontract with other providers to join up care in public sector partnerships..

Where this is happening, the emphasis on collaboration between commissioners and providers appears to run counter to the intention that the proposed contract should be used in a competitive procurement process. Clinical commissioning groups are also often uncertain on when they are required to go out to tender for the services they commission and are alert to the possibility of legal challenges from private companies who may feel excluded from decisions to keep contracts within the NHS family. The NHS market may be dying but is not yet dead, underlining the tension at the heart of recent developments.

For the foreseeable future, the NHS and its partners will have to live with this tension and the ambiguity it creates. They will also hope that the political will can be found before too long to align the law with the priority now being given to integrated care and partnership working. Is it too much to expect a cross party consensus to emerge that will make this possible?

Five years after launching the first Baby Changing Room Awards and sponsoring the National Childbirth Trust Baby Change App, Britain’s leading nappy cream brand Sudocrem is once again pioneering the way with a new category to recognise the importance of Changing Places toilets for disabled children.

There are 800,000 disabled children in the UK but only 1058 Changing Places toilets to meet their needs. This means that parents like Laura Rutherford, whose son Brody, 5, suffers from GDD, epilepsy, hypermobility and hypotonia, is forced to change her son on a toilet floor. “Life beyond a baby changing table when your child is doubly incontinent means constant exclusions when you go out as a family. It’s heart breaking for us as parents and this is an issue that will sadly become harder and harder as he grows up. He is different not less. Time for change.”

Since 2012, Sudocrem has campaigned for change with an award scheme to recognise the importance of good nappy changing facilities. Past winners have included Mothercare, John Lewis, Sainsbury’s and the National Museums of Scotland.

“From day one, we wanted to show that baby changing rooms are important and often over-looked. We’re proud that our campaign has been recognised and won the OTC Marketing Award 2017. Now we’re ready to tackle the issue of facilities for disabled children by working with the charity PAMIS (Promoting A More Inclusive Society) to highlight the Changing Places facilities that organisations such as Arsenal Football Club have put in to make a difference to a wider range of people. It’s all about inspiring people by setting a good example.”

There are three categories for this year’s award scheme:

Baby Changing Room of the Year

Dad’s Changing Rooms

Changing Places Toilet (in association with PAMIS)

Jenny Miller CEO of PAMIS explains, “We are thrilled that Sudocrem have recognized the needs of children with complex needs as they grow too large for baby changing facilities. Children and young people who require these facilities are often prevented from taking part in their communities by the simple things that we take for granted. In 2007 we cofounded the Changing Places Consortium and campaign to develop accessible facilities for the most disabled people in the UK. The Sudocrem award scheme is a great idea and we’re confident it’s going to make a big difference!

Entries will be judged by the NCT, PAMIS and Sudocrem. The closing date for entries is March 26th 2018 and the winners will be announced by the March 30th 2018.

The winning facilities will receive an engraved plaque. Everyone who nominates their favourite facilities will also be entered in to a prize draw for the chance to win a short break at a family friendly hotel.

*Terms & Conditions apply

Notes to Editors:

Sudocrem:

Experts in healing, soothing and protecting families skin since 1931, Sudocrem is a brand with heritage, trusted by generations

First created in Dublin, Ireland, by Thomas Smith, Sudocrem is the No.1 nappy care brand in 15 countries around the world.

10 million Sudocrem products are sold annually.

Multi award winning, Sudocrem is committed to leading the way in new product development, education and corporate social responsibility. In 2017 alone, Sudocrem supported playground regeneration through Play More, improved changing room facilities for parents and sponsored Britain’s biggest parenting charity the NCT.

NCT

The National Childbirth Trust was established in 1956. It is a UK-based charity offering information and support in pregnancy, childbirth and early parenthood. It has worked with Sudocrem on the Baby Changing Room Awards for 3 years.

PAMIS:

PAMIS (Promoting A More Inclusive Society) was established in 1992 and supports people with profound and multiple learning disabilities. Ten years ago, PAMIS cofounded the Changing Places Consortium and campaign to develop fully accessible toilets in the UK. A Changing Places toilet must be 12 square meters and have an adjustable bench, a tracking hoist, peninsula toilets and a stoma shelf.